MENTAL HEALTH
YOUR MONEY OR YOUR MENTAL HEALTH Susan Bornstein , MD
World Mental Health Day was
Oct . 10 , but given the state of the nation , and the world , every day should be mental health day .
Mental illness is quite common , affecting one in five US adults , or 51.5 million 1 people in 2019 . That means almost all of us know at least one person , probably many people ( whether we know it or not ) who suffer from some type of mental malady . The COVID-19 pandemic has made the situation worse . A June 2020 survey published by the Centers for Disease Control and Prevention reported that 40 % of US adults 2 were struggling with mental health or substance use . A survey 3 from the Commonwealth Fund using data from March to May 2020 revealed that one in three US adults were experiencing stress , anxiety or great sadness . This is hardly surprising . The pandemic has caused disruption of our normal routines , loss of social support , upheaval in schooling and severely diminished in-person contact with anyone who resides outside of our homes , including family , our closest friends , our work colleagues and even casual , but rewarding brief interactions — the mail person , the clerk at Kroger , or our favorite waitstaff at our regular restaurant . Family and holiday celebrations have been scaled down , cancelled or postponed indefinitely . Mourning rituals , which provide structure and comfort to our grief , have been attenuated , or vanquished altogether . None of these life-altering changes are advantageous to our mental health . They are likely to reverberate far into the future .
In addition to its solitary burden , mental illness is also closely associated with other co-morbidities ( illnesses or conditions which compromise our health ) and toxic coping strategies . 37 % 4 of adults with any mental illness , such as severe anxiety , depression or schizophrenia , also use illicit drugs . 31 % 4 are binge consumers of alcohol , often in a self-help attempt to feel better . This substance abuse then leads to further fallout , such as job loss or homelessness . Patients with mental illness are more likely to miss work or school , have legal and financial problems , inadequate social support , live in poverty and have other general medical conditions . 5 Both mental illness and substance abuse are associated with impaired judgement and high risk behaviors , including sexual promiscuity , 6 and may result in suicide . 5
A substantial proportion of mental illness is insufficiently treated . The 2019 National Mental Health Services Survey 4 showed that in 2018 , less than half of adults with any mental illness ( 43 %) received mental health services . This translates to nearly 60 % being untreated .
The single largest reason for unmet care was cost . Historically , insurance companies have reimbursed for mental health services at much lower levels than for physical illness . The carriers imposed separate copay charges for mental health services , separate limitations on lengths of stay in in-patient facilities , and separate ceilings on mental health coverage , as compared to other medical and surgical services . These disparities were partially addressed with the Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008 , which required large group employer-based insurance policies to cover mental health services at the same levels as medical and surgical services . The Affordable Care Act ( ACA ) expanded coverage more by requiring individual , small group and Medicaid expansion plans to do the same . 7
20 LOUISVILLE MEDICINE